I feel very jerked around by them and my mother needs her funds to stay in assisted living. I'm ready to pull my hair out with these people. They approved her on her second application. They told me the funds would begin to come into her account as of March. I never received a letter of acceptance. NOW they say they never got an invoice from her long term health care? Then never told me they needed this . I'd like to know what the H is going on. Where is my letter of acceptance? PLUS they would not approve her receiving payment until AFTER she moved in. So that after she leaves her home they decide if she can get reimbursed. And if they feel she does not qualify THEY SHE IS WHAT...HOMELESS??? It is abusive. My mother has been paying into this program for over 15 years. She needs the care due to Pulminary Fibrosis and memory issues. She is 86. We are using up her money faster they we had planned and this is creating a great deal of anxiety for me. There is no way my mom can live with me. I am besides myself. Any suggestions?

6 Answers

Jeannie & Yoga - Genworth is kinda the market leader for LTC. They are a solid as far as the LTC's are concerned. A few years back they had significant increases to older (like 1970's & 1980's policies) as no inflation riders & they could increase if needed.

For any LTC, the devil is going to be in requirements & amount for payout. Most are going to have a period of self pay…. maybe 30 days but could be 120 days or more. Often "rehab" days not included in that period as not within what the policy considers LTC. AL is sticky too for LTC as often "care" provided is not within the policy.

Its not unusual for payout to finally finally start and by that time they have gotten sicker and now on hospice.

Ruth, please read the policy to see just when the LTC will kick in, payout amount and if there are specific diagnosis, nursing care, etc. needed. If still in the self-pay phase, find out exactly what is day 1 and what documentation is needed from the AL to transition. I would do letters to whatever address as per policy plus to McInherney & Schneider, all certified mail with the return receipt (both from the USPO and around $ 8.00). Having the return receipt is important as its a date with signature, so nobody can contest your contacting them. If you fax, pls send faxes from someplace that you get a time stamped transmission report.

As an aside on this, my mom's NH did NOT take any LTC for payment. Medicare, Medicaid or private pay only. Their rationale was that each LTC group had their own requirements from the NH in order to pay. Some wanted detailed info on staffing; others wanted all sorts of details on medical beyond ICD codes. Always some sort of delay. So just not worth it, at least for this NH which was part of a small 6 facility group in 4 counties.

Hi Ruth, My suggestion is to write a detailed and clear letter explaining the situation and the steps you have taken. Of course include the predicament this is leaving you in. I would write it to the Pres. and copy the Chief Operating officer (see below) . If you prefer email, use first name dot last name at genworth dot com Correspondence of this nature is fast tracked and given a VERY high priority. If you don't get satisfaction, call the insurance commissioner for your state and follow that up with a copy of the previous correspondence. This could be anything from a new claims processor not going through the entire file to who knows what. Good luck. Let us know how this works out. Tom McInerneyPresident and Chief Executive OfficerGenworth Financial6620 West Broad StreetRichmond, VA 23230~~~Kevin D. SchneiderExecutive Vice President and Chief Operating Officer700 Main StreetLynchburg, VA 24505

Oh dear. I am very sorry to hear this. That is my long-term insurance company, too. I've been paying in for 15 years. It would be awful to have those kinds of issues when the time comes for me to collect! I am so sorry to hear of your problems.

For many of us caregivers, the absolute most frustrating aspect of caring for an elder is dealing with insurance and bureaucratic officials. But you can do it! Take a deep breath and force yourself to deal with this step-by-step. Try to keep your calm and try not to sound belligerent. (Hard, I know!)

Do what they say they want. Send them a statement from the facility, along with a letter outlining what has been going on just as you did here. Stay polite and stick to the facts. Say what you want. (An acceptance letter, for example.) End the letter something like "I look forward to your help in resolving this matter.) Send the letter registered mail.

That is round one. It may be enough. If not, escalate to the regional manager. Copy the Insurance Commissioner on the letter, or the consumer protection office if that is what your state has.

If the office isn't too far from you, show up in person.

I think that once this is set up it should work smoothly. Grit your teeth and do what ya gotta do. You'll get through this! And Mom won't be homeless.

I am very sorry to say that this kind of frustration is common, because common sense seems to be absent in some of these offices.

Do let us know how this progresses and what you do that works. These are the kind of tips many caregivers can use!

(I just read CountryMouse's answer. We were typing at the same time. I guess things work pretty much the same way in and out of the US!)

Most Long Term care plans do not pay out immediately. Be aware they only pay out the daily amount that you purchased for the period of time you purchased. So if she bought a $100 a day plan that pays out for two years, that is all you will get. All the plans need some sort of invoice to substantiate the payment. Read the whole contract.

Next, retrieve all of the paperwork you can from when your mother first took out the policy.

Monday morning, having digested all the terms and conditions and checked that your mother's claim is valid, call them up and start again. Always take the name of the person you're speaking to. Always note the date, time and content of the conversation.

Take down step by step instructions for what they want you to do to ensure that they remit the right fee to the right place at the right time. Then do that.

When it goes wrong, again, just repeat. In the end, you will iron out the wrinkles and things will start running smoothly. Have faith.

I don't, naturally - I'm in the UK - know this particular provider; but essentially they're all the same. We had exactly this kind of fun and games fifteen years ago with PPP (and if they don't like being named they can bite me). Paying up doesn't seem to be the strong suit of any insurance company, but it's almost always cock-up and not conspiracy. If your mother's claim is valid, they will pay in the end - once they've got the right form, and lost it, and got another one, and filled it in in triplicate, and sent the money to the wrong facility for the wrong patient...

Which reminds me - ALWAYS quote the policy number, and always check they're looking at the right person.

And tell the facility that x% of their invoice is covered by this ltc policy - it'll quieten them down a bit knowing the money's on its way. Eventually :(

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